Caring for Asian immigrants: Tips on culture that can enhance patient care

,; ,; ,

Applied Evidence

Caring for Asian immigrants: Tips on culture that can enhance patient care

J Fam Pract. 2014 January;63(1):E1-E9

PDF Download

References

1. Min PG, ed. Asian Americans: Contemporary Trends and Issues. 2nd ed. Thousand Oaks, California: Pine Forge Press; 2006.

2. Ortman JM, Guarneri CE; National Census Bureau. United States population projections: 2000 to 2050. Available at: http://www.census.gov/population/projections/files/analytical-document09.pdf. Accessed February 20, 2012.

3. Barnes JS, Bennett CE; US Census Bureau Web site. The Asian population: 2000. Available at: http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf. Published February 2002. Accessed February 2, 2012.

4. Kim G, Worley CB, Allen RS, et al. Vulnerability of older Latino and Asian immigrants with limited English proficiency. J Am Geriatr Soc. 2011;59:1246-1252.

5. Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health. 2012;14:350-355.

6. US Department of Health and Human Services Office of Minority Health Web site. The National CLAS Standards. Available at: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15. Updated May 3, 2013. Accessed June 1, 2013.

7. Karliner LS, Jacobs EA, Chen AH, et al. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42:727-754.

8. Wilson E, Chen AH, Grumbach K, et al. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20:800-806.

9. Ku L, Flores G. Pay now or pay later: providing interpreter services in health care. Health Aff (Millwood). 2005;24:435-444.

10. Ngo-Metzger Q, Massagali MP, Clarridge BR, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18:44-52.

11. Basabe N, Ros M. Cultural dimensions and social behavior correlates: individualism-collectivism and power distance. Revue Internationale De Pscyhologie Sociale. 2005;17:189-225.

12. Ngo-Metzger Q, Legedza AT, Phillips RS. Asian Americans’ reports of their health care experiences. Results of a national survey. J Gen Intern Med. 2004;19:111-119.

13. Collins KS, Hughes DL, Doty MM, et al; The Commonwealth Fund. Diverse communities, common concerns: assessing health care quality for minority Americans. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2002/Mar/Diverse-Communities--Common-Concerns--Assessing-Health-Care-Quality-for-Minority-Americans.aspx. Published March 2002. Accessed December 20, 2013.

14. Houston HR, Harada N, Makinodan T. Development of a culturally sensitive educational intervention program to reduce high incidence of tuberculosis among foreign-born Vietnamese. Ethn Health. 2002;7:255-265.

15. Mazurel GH, Jereb J, Vernon A, et al; Centers for Disease Control and Prevention (CDC). Updated guidelines for using interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection—United States, 2010. MMWR Recomm Rep. 2010;59(RR-5):1-25.

16. Hutton DW, Tan D, So SK, et al. Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B. Ann Intern Med. 2007;147:460-469.

17. Fattovich G, Brollo L, Giustina G, et al. Natural history and prognostic factors in chronic hepatitis B. Gut. 1991;32:294-298.

18. Beasley RP. Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer. 1988;61:1942-1956.

19. Smith C. Managing Adult Patients with Chronic HBV. Hepatitis B Foundation. Accessed February 15, 2012, at http://www.hepb.org/professionals/management_guidelines.htm.

20. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020-1022.

21. Hamaad A, Lip G. Assessing heart disease in your ethnic patients. Pulse. 2003;63:48-49.

22. Gupta M, Singh N, Verma S. South Asians and cardiovascular risk: what clinicians should know. Circulation. 2006;113:e924-e929.

23. Venkataraman R, Nanda NC, Beweja G, et al. Prevalence of diabetes mellitus and related conditions in Asian Indians living in the United States. Am J Cardiol. 2004;94:977-980.

24. Nishtar S. Prevention of coronary heart disease in south Asia. Lancet. 2002;360:1015-1018.

25. Browne SK, Burbelo PD, Chetchotisakd P, et al. Adult onset immunodeficiency in Thailand and Taiwan. N Engl J Med. 2012;367:725-734.

26. Sorkin DH, Nguyen H, Ngo-Metzger Q. Assessing the mental health needs and barriers to care among a diverse sample of Asian American older adults. J Gen Intern Med. 2011;26:595-602.

27. PTSD, depression epidemic among Cambodian immigrants [press release]. Bethesda, MD: National Institutes of Health; August 2, 2005.

28. Sue S, Sue DW, Sue L, et al. Psychopathology among Asian Americans: a model minority? Cult Divers Ment Health. 1995;1:39-51.

29. Parker G, Cheah YC, Roy K. Do the Chinese somaticize depression? A cross-cultural study. Soc Psychiatry Psychiatr Epidemiol. 2001;36:287-293.

30. Sribney W, Elliot K, Aguilar-Gaxiola S, et al. The role of nonmedical human services and alternative medicine. In: Ruiz P, Primm A, eds. Disparities in Psychiatric Care. Baltimore, MD: Lippincott, Williams & Wilkins; 2010:274-289.

31. Lee HY, Lytle K, Yang PN, et al. Mental health literacy in Hmong and Cambodian elderly refugees: a barrier to understanding, recognizing, and responding to depression. Int J Aging Hum Dev. 2010;71:323-344.

32. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthroplologic and cross-cultural research. Ann Intern Med. 1978;88:251-258.

33. Patwardhan B, Warude D, Pushpangadan P, et al. Ayurveda and traditional Chinese medicine: a comparative overview. Evid Based Complement Alternat Med. 2005;2:465-473.

34. Wu AP, Burke A, LeBaron S. Use of traditional medicine by immigrant Chinese patients. Fam Med. 2007;39:195-200.

35. Nguyen G, Bowman M. Culture, language, and health literacy: communicating about health with Asians and Pacific Islanders. Fam Med. 2007;39:208-210.

36. Oates RK. Overturning the diagnosis of child abuse. Arch Dis Child. 1984;59:665-666.

37. Efferth T, Kaina B. Toxicities by herbal medicines with emphasis to traditional Chinese medicine. Curr Drug Metab. 2011;12:989-996.

38. Galanti G. Communication and time orientation. In: Caring for Patients from Different Cultures. 4th ed. Philadelphia, PA: University of Pennsylvania Press; 2008:27-51.

39. Berlin E, Fowkes WC Jr. A teaching framework for cross-cultural health care: application in family practice. West J Med. 1983;139:934-938.

40. Stuart MR, Lieberman JA III, eds. The Fifteen Minute Hour: Applied Psychotherapy for the Primary Care Physician. 2nd ed. Westport, CT: Praeger; 1993:101-183.

41. Kobylarz FA, Heath JM, Like RC. The ETHNIC(S) mnemonic: a clinical tool for ethnogeriatric education. J Am Geriat Soc. 2002;50:1582-1589.

42. Kountz DS. Strategies for improving low health literacy. Postgrad Med. 2009;121:171-177.

43. Patient Activation Measure Assessment. Insignia Health Web site. Available at: http://www.insigniahealth.com/solutions/patientactivation-measure. Accessed February 20, 2012.

44. Glenn-Vega A. Achieving a more minority-friendly practice. Fam Pract Manag. 2002;9:39-43.

45. Galanti G. Making a Difference. In: Caring for Patients from Different Cultures. 3rd ed. Philadelphia, PA: University of Pennsylvania Press; 2003:1222-1229.

46. SPIRAL: Selected Patient Information in Asian Languages. Tufts University Hirsh Health Sciences Web site. Available at: http://spiral.tufts.edu/topic.shtml. Accessed February 10, 2012.

Teach back and patient activation

An extremely useful technique for all cultures is termed “teach back” or “show me,” which involves asking patients to repeat their care instructions at the end of the visit. This extra step provides an opportunity to correct errors that might have occurred during the transmission of instructions.⁴² Caregivers should also encourage or “activate” patients to become more involved in managing their own health care. Patient activation measures may be assessed on a one-to-4 point scale.⁴³Using both of these techniques combats passivity, promotes patient acceptance, and improves outcomes.

A caring environment

There are various strategies and approaches that can help make a medical practice more immigrant friendly (TABLE 4).^44,45 Instructing office staff to assist patients in getting to the clinic is critical for those with limited mobility or who lack English proficiency. Adding evening hours that can also accommodate walk-ins helps working patients. For practices with larger immigrant populations, recognizing Asian holidays like Chinese New Year, Diwali, or Tet will be well received. These practices have been directly correlated with more positive health outcomes and better patient satisfaction.⁴⁴

Conveying complex instructions to patients with little English takes effort for even the most unflappable providers. While written follow-up instructions in English could be interpreted by a more fluent family member, the ideal solution would be to have materials available in the native language. Fortunately, several Web sites, such as SPIRAL (Selective Patient Information in Asian Languages) provide downloadable Asian language instructions.⁴⁶

Physicians should try to implement the Culturally & Linguistically Appropriate Services (CLAS) guidelines and mandates from the Office of Minority Health (http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15).⁶ They go far towards providing optimal care for patients of all cultures. Cultural competence does not imply being an expert in all cultures, let alone those of Asia. However, health care providers can develop the skills necessary for effective cross-cultural communication, which, to be most effective, must be accompanied by a caring attitude and respectful practice environment.

CORRESPONDENCE
Gregory Juckett, MD, MPH, West Virginia University School of Medicine, Box 9247, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, 26506; gjuckett@hsc.wvu.edu